MRCOG ENHANCED REVISION PROGRAMME
Author: Dr Lisa Joels MD Royal Devon & Exeter NHS Trust
Dr Sanjeev Sharma Southport and Ormskirk NHS Trust

MRCOG Written Examination
Paper:
Length:
SBA Paper & EMQ Paper
3 hour paper (180 minutes)
Question numbers 50 Single Best Answer Questions
50 Extended Matching Questions
Timing advice
Candidates are responsible for their own time management.
However, our recommendation is that candidates should spend,
70 minutes on the SBA questions, and
110 minutes on the EMQ questions.
ENHANCED REVISION PROGRAMME
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp

Single best answer questions
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application of knowledge
-data interpretation
-problem solving
-decision making
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ENHANCED REVISION PROGRAMME
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp

SBA - How it works ?
• An answer sheet numbered from 1 to 50 (for each of the questions).
• Against each number there are 5 lozenges labeled A-E
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

SBA - How it works ?
• A lead-in statement (which tells you what to do)
• An option list labeled A-E (lettered to reflect the answer sheet)
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
• Identified from curriculum modules and domains (necessary for blueprinting of SBAs, EMQs and Clinical Assessment).
• Sources - Green top guidelines, NICE guidelines, good practice guidance, patient information, clinical governance, TOG articles, StratOg, textbooks.
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
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ENHANCED REVISION PROGRAMME
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp

Single Best Answer
Question : 1
A 29 year old G1P0 patient at 15 weeks gestational age presents to your clinic complaining of some shortness of breath that is more intense with exertion. She has no significant past medical history and is not on any medication. The patient denies any chest pain but sometimes feels as though her heart is pounding. She is concerned because she has always been very athletic and cannot maintain the same degree of exercise that she was accustomed to prior to becoming pregnant. On physical examination, her pulse is 90 per minute. Her blood pressure is 90/50. On cardiac examination a systolic ejection murmur is identified. The lungs are clear to auscultation and percussion.
Lead - in
The following is the most appropriate next step to pursue in the work up of this patient?
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Options: a) Refer the patient for a ventilation perfusion scan to rule out pulmonary embolism b) Perform an arterial blood gas c) Refer the patient to a Cardiologist d) Reassure the patient e) Order an ECG
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Question: 2
Your patient is a healthy 29 year old G2 P1 at 20 weeks gestational age. Two years ago, she vaginally delivered a term a healthy baby boy weighing 6lb
8oz. This pregnancy, she had a pre-pregnancy weight of 130lbs. She is 5ft
4in tall. She now weights 140lbs and is extremely nervous that she is gaining too much weight. She is worried that the baby will be too big and require her to have a Caesarean section.
Lead - in
How do you counsel this patient?
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Options: a) Her weight gain is excessive and she needs to be referred for nutritional counselling to slow down her rate of weight gain.
b) Her weight gain is excessive and you recommend that she undergo early glucose screening to rule out gestational diabetes.
c) She is gaining weight at a less than normal rate and with her history of a small for gestational age baby, she should supplement her diet with extra calories.
d) During the pregnancy she should consume an additional 300kcal/day vs. pre pregnancy and her weight gain so far is appropriate for her gestational age.
e) During the pregnancy she should consume and additional 500kcal/day vs. pre pregnancy and her weight gain is appropriate for her gestational age.
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Question: 3
A 28 year old nulligravid patient complains of bleeding between her periods and increasingly heavy menses. Over the past 9 months she has hard two dilation and curettages (D & C’s), which have failed to resolve her symptoms, and oral contraceptives and antiprostaglandins have not decreased the abnormal bleeding.
Lead – in
Of the following options, which is most appropriate at this time?
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Options: a) Perform a hysterectomy b) Perform hysteroscopy c) Perform endometrial ablation d) Treat with GnRH agonist e) Start the patient on a high dose progestational agent
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Question: 4
A patient is seen on the second post operative day after a difficult abdominal hysterectomy complicated by haemorrhage from the left uterine artery pedicle. Multiple sutures were placed into this area to control bleeding. The patient now has fever, left back pain, left costovertebral angle tenderness and haematuria. An ultrasound examination shows that fluid has accumulated in the left flank. A ureteral injury is diagnosed.
Lead – in
If the injury had been recognized at the time of surgery, which of the following procedures could have been recommended?
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Single Best Answer
Options: a) Percutaneous nephrostomy b) Placement of a ureteral stent without anastomosis c) Intraperitoneal drainage without anastomosis d) Uretero-ureteral anastomosis e) Ureteral reimplantation into the bladder
ENHANCED REVISION PROGRAMME www.rcog.org.uk/erp

Single Best Answer
Question: 5
A 22 year old shop assistant attends the emergency gynaecology clinic the morning after she got drunk at a hen party and had sexual intercourse with a male stripper. She stopped taking the oral contraceptive pill a few months ago as she was gaining weight.
Lead – in
Which is the most important aspect of her sexual history when considering emergency contraception?
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Options: a. Number of sexual partners in the last three months b. Interval since last unprotected sexual intercourse c. Symptoms of sexually transmitted infections d. Past obstetric history e. Interval since first unprotected intercourse
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Question: 6
A 19 year old woman is admitted to intensive care with a severe asthma attack after being prescribed ulipristal acetate for emergency contraception. She was known to be a poorly controlled asthmatic. The ST1 admits to you they didn’t check the contraindications for this drug before prescribing it
Lead – in
What is the most appropriate next step?
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Options: a. Arrange a tutorial for all the ST1s and ST2s b. Submit an incident report c. Debrief the ST1 with a written record d. Inform the Royal College Tutor e. Inform the Medical Director
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Question: 7
The first patient in the emergency gynaecology clinic on Tuesday morning is a 21 year old nulliparous woman requesting emergency contraception.
She got drunk at a music festival and had casual unprotected sex on Friday night. She is fit and well and is not in a relationship.
Lead – in
Select the most appropriate immediate action from the options below:
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Options: a. Screen for sexually transmitted infections b. Arrange an HIV test c. Insert a copper intrauterine contraceptive device d. Prescribe ulipristal acetate 30mg c. Prescribe Levonorgestrel 1.5mg
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Question: 8
A 26 year old woman requests contraceptive advice four weeks after her first child was born by emergency caesarean section. She is breast feeding with supplementary bottle feeding through the night and wants to space her family.
Lead – in
What would be the most appropriate advice?
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Options: a. Reassure, no additional contraception needed b. Combined oral contraceptive pill c. Diaphragm d. Desogestrel e. Levonorgestrel intrauterine system
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Question: 9
A 15 year old girl attends your GP surgery requesting contraception as she is sexually active using condoms but wants a more secure form of contraception.
She has no relevant past medical history and you deem her to have Lord
Fraser competency.
Lead – in
Which is the best form of contraception for her?
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Options: a. Co-cyprindiol b. Combined oral contraceptive pill c. Depot medroxy progesterone acetate d. Etonorgestrel subdermal implant
E. Levonorgestrel intrauterine device
ENHANCED REVISION PROGRAMME
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp

Single Best Answer
Question: 10
A routine anomaly scan at approximately 20 weeks gestation in the first pregnancy of a 24 year old woman showed a cardiac abnormality. A second opinion was sought from a tertiary fetal medicine centre and a fetal echocardiogram has shown that the baby has a hypoplastic left heart. After consultations with a neonatal cardiac surgeon and
Paediatric cardiologist, the woman and her husband have taken the difficult decision to terminate the pregnancy which is now 22+2 weeks gestation.
Lead - in
Which of the following statements is most applicable to this couple?
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME

Single Best Answer
Options: a. Termination of pregnancy with mifepristone and misoprostol
B. Induce labour with ARM and syntocinon c. Offer feticide d. Termination of pregnancy with two oral doses of 600mg mifepristone e. Advise that TOP after 22 weeks is not available
© Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/erp ENHANCED REVISION PROGRAMME